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Na+ K+ Ca2+ Mg2+ PO4- Flashcards

1
Q

Normal range for sodium?

A

135-145 mmol/L

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2
Q

Normal range for potassium?

A

3.5- 5.3mmol/ L

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3
Q

List three drugs that may cause hypernatraemia?

A

Mineralocorticoids- hydrocortisone, fludrocortisone
Phenytoin
Lithium

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4
Q

What are the signs and symptoms of hypernatraemia?

A 
Thirst 
Lethargy 
Confusion 
Irritability 
Restlessness 
Nausea and vomitting 
Fever
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5
Q

Can you think of a class of drugs that can cause hyponatreamia?

A 
Antidepressants:
TCAs
SSRIs
MAOIs
Carbamazepine 
Haloperidol
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6
Q

What are the signs and symptoms of hyponatreamia?

A 
Can show no symptoms at all until under 120 mmol/ L
Muscle Weakness
Nausea and vomitting
Lethargy 
Seizures/ neurological signs/ coma
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7
Q

What does hypervolemia mean?

A

It is a state of decreased blood volume; more specifically, decrease in volume of blood- Hypovolemia is characterized by sodium depletion (salt depletion)

Hypovolemic shock, also known as hemorrhagic shock, is a life-threatening condition that results when you lose more than 20 percent (one-fifth) of your body’s blood or fluid supply.

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8
Q

What can too rapid correction of sodium lead to?

A

Brain swelling and raised intracranial pressure

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9
Q

Hyperkalaemia can be caused by excessive cellular breakdown. What are some examples of this?

A 
Haemolysis
Burns
Surgery
Infection 
Rhabdomylosis
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10
Q

How does hyperkalaemia result in arrhythmias?

A

Abnormal levels affect excitability of nerve and muscle tissue (myocardial tissue), leading to arrhythmias (NB this also caused by hypokalaemia)

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11
Q

What drugs can cause hyperkalaemia? How?

A

ACE inhibitors

K+ sparing diuretics- 
Amiloride
Triamterene
Eplerenone
Spironolactone
Trimethoprim

Heparins

Theophylline

Renal K+ excretion is mediated by aldosterone and sodium (Na+) delivery.. These drugs impair aldosterone synthesis

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12
Q

How do we manage hyperkalaemia?

A

1) protect the myocardium using Calcium GLUCONATE 10%
2) Move K+ back into cells using INSULIN (Actrapid- give in 20% dextrose to counteract hypoglycaemia)
3) 10mg Salbutamol neb- causes hypokalaemia

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13
Q

What can be used to REMOVE K+ in hyperkalaemia?

A

Dialysis

Calcium resonium

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14
Q

What are the signs and symptoms of hyperkalaemia?

A

Muscle weakness
ECG changes/ arrhythmia
Sudden death

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15
Q

Can INSULIN cause hyperkalaemia or hypokalaemia?

A

Hypokalaemia

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16
Q

Do beta-2 adrenergic receptor agonists (e.g. salbutamol), cause hypokalaemia or hyperkalaemia?

A

hypokalaemia

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17
Q

What are the symptoms of hypokalaemia?

A 
Fatigue
Drowsiness
Dizziness
Confusion
Electrocardiographic changes
weakness
Muscle pain.
Arrythmias
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18
Q

Hypokalaemia can be corrected through administration of IV potassium 40mmol/L fluids. Why is central administration preferred?

A

Due to risk of thrombophlebitis with peripheral administration.

19
Q

How can metabolic acidosis result in hyperkalaemia?

A

acidosis – K+ exchanged for H+ across cell membrane. K+ leaves cells and causes hyperkalaemia.

20
Q

What is the normal range for calcium?

A

2.15 to 2.6 mmol/L

21
Q

What drugs may cause hypercalcaemia?

A

Thiazide diuretics

Tamoxifen

22
Q

What is the role of potassium with regard to physiological function?

A

it is responsible for cellular processes:

resting cell membrane potential and action potentials in neuronal, muscular, and cardiac tissues

23
Q

What is the role of sodium with regard to physiological function?

A

Osmolarity balance

It regulates blood volume, blood pressure, osmotic equilibrium and pH.

24
Q

What is the role of phosphate with regard to physiological function?

A

Energy metabolism- Important in energy (ATP) formation and for the structural integrity of cell membrane

25
Q

What is the role of calcium with regard to physiological function?

A

Calcification of bones and teeth and regulation of metabolism/excitation of nerve cells in cardiac conduction.

26
Q

What is the role of magnesium with regard to physiological function?

A

Hormone regulation (thyroxine, GH, PTH, aldosterone, ADH, calcium magnesium pump)

27
Q

What are the signs/ symptoms of hypocalcaemia?

A 
Numbness or burning in the extremities
Tingling
General malaise
Confusion
Prolonged QT interval/ ECG changes
Muscle cramps
28
Q

What is the normal range of magnesium?

A

0.7-1.0 mmol/L

29
Q

What drugs can cause low magnesium?

A

Diuretics
Digoxin
Amphotericin
Aminoglycosides- gentamicin, amikacin

30
Q

What are the signs and symptoms of low magnesium?

A 
Irritability
Tremor (remember on-call baby scenario)
Ataxia- muscle jerks
Hallucinations
Prolonged QT interval
Epilepsy
Tachycardia
31
Q

What electrolyte deficiency does hypo-magnesia commonly occur with?

A

Often occurs with hypocalcaemia, and must be treated in order to fully treat low calcium

32
Q

what are the signs and symptoms of Hypermagnesia?

A 
Weakness 
drowsiness
Respiratory paralysis
Muscle paralysis
Nausea and vomiting
Bradycardia
cardiac arrest
33
Q

What class of drugs can cause hyper magnesia?

34
Q

What is the normal range for phosphate?

A

0.8 to 1.4 mmol/L

35
Q

What disease states can give rise to hyperphosphataemia?

A

Renal insufficiency (especially relate to rhabdomyolysis)
HYPOCALCEAMIA
Hypoparathyroidism
Rhabdomylosis

36
Q

What are the symptoms of hyperphosphataemia?

A 
Itching
The other symptoms are due to hypocalceamia:
Numbness or burning in the extremities
Tingling
Confusion
Prolonged QT interval/ ECG changes
Muscle cramps
37
Q

Phosphate plasma levels are related to the other electrolyte ________. As the levels of one rises, the levels of the other decline.

A

Plasma levels are related to calcium

So if calcium levels decrease, phosphate levels rise

38
Q

What disease states can cause hypophosphateamia?

A

Respiratory acidosis
Hyperparathyroidism
Chronic diarrhoea
Malnutrition- refeeding syndrome

39
Q

What are the methods of replacing potassium or reducing levels if too high?

A 
Replace with sando K or IV potassium if required quickly  
Reduce with:
calcium gluconate 
insulin and glucose 
salbutamol
40
Q

What are the methods of replacing sodium ?

A

Replace with slow sodium or NaCl 30%

41
Q

What are the methods of replacing calcium ? What can be used if levels are too high?

A

Replace with calcichew, sandocal or calcium gluconate.
If levels too high: Bisphosphonates can be use (Most effective when caused by malignant disease): Pamidronate-After rehydration

42
Q

What are the methods of replacing magnesium ?

A

Replace with magnesium glycerophosphate or aspartate sachets or magnesium IV

43
Q

What are the methods of replacing phosphate? What if levels are too high?

A

Replace with Phosphate Sandoz or IV phosphate
Calcium salts as phosphate binders
Sevelamer (phosphate binding agents)
Lanthanum

DIPLOMA (11 decks)

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